The Epidemiologic Investigation On Sub-health Status And Proteome Research Of Kidney-Yin Deficiency Syndrome

【Background】In 1980s, Professor Berkman from the former Soviet Union hasdiscovered by his studying that the human body existed one kind of intermediate statebetween health and disease, which he called "the 3rd state". One result from WHO'sglobal investigation indicates that the really healthy people (the 1st state) accounts for5% only. And people who are examined and diagnosed ill by doctor (the 2nd state)take 20%. 75% people are in the 3rd state which is not healthy and not ill. Due to thehigh incidence of sub-health and its impact on people's quality of survival, thedomestic medical group has regarded it as an important subject endangering people'shealth. The research on sub-health has been one important component in the study oflife science.The sub-health status is one state between health and illness for body and mind.The body doesn't give an obvious disease, but the person feels uncomfortable in body,mentality and human communication, displaying one kind of physiology state that thevigor, reaction ability and acclimatization ability are weakening. This state is mainlycaused by the hypofunction on physiology and metaboly. It is not yet a disease, butalready seriously affect people's working efficiency and living standard. Presently itis considered that sub-health status may happen on various factors such as people'ssituation of body and mentality, life style, occupation condition, living environment,social activities etc. Now china already carried out the sample research on the groupsof colleague students, university teachers, office cadres and soldiers, etc. The resultdemonstrates various people have different clinical symptom and occurrence factor.Therefore, it will help on prevention and cure of sub-health status to carry outlarge-scale epidemiology research in given groups. Being short of clear physical and chemical evidence of a disease, sub-healthstatus can not be called "some disease". It is actually a syndrome to show thatsomething wrong with physiology activities of the body. It is the early phasereporting the abnormality of the body. Takeing concrete configuration as the basis,simple biological disease as the object of study, digitized checkout data as thediagnosing law, it is therefore very difficult to grasp the rule of diagnosing andtreating sub-health status according to modern medicine. Traditional ChineseMedicine is one theory system which regards the human body itself as a whole andcharacterizes by Treatment by Differentiation of Syndromes(TDS). Its main characterdifferent from the modern medicine is that it gives an important role to physiologicalcharacter and functional rule of the body. Thus, TCM has a comprehensive advantageon knowing the essence of sub-health status and the way of diagnosis and treatment.TDS is the basis and characteristic essential of TCM. Syndrome is the basis andpremise of TDS. It is also the key and bridge of connecting theory of TCM andsystem of clinical diagnosis and treatment. The syndrome research is the key and hotspot of modern study on TCM. But all the time there is no really big progress on thestudy. Probably there is something wrong with the study methods and researchdirections. We have found that it is a very ideal entrance to study the nature of TCMsyndrome starting with the sub-healthy research. Because sub-health status is the 3rdstate between health and illness. There is nothing wrong shown by clinical checkout.Thus it can not be diagnosed as some disease by modern medicine. But it alreadyshows various symptoms, which is syndrome of TCM and not affected by the illnessof modern medicine. So the syndrome is the most ideal object of study. But it also hascertain shortages. The symptoms shown by sub-health status may not represent allcharacters of syndrome of TCM, but can possibly reflect a syndrome's most essentialcharacter. Thus it can not only provide theoretical basis and practical guidance on theprevention and cure of sub-health status, but also boost a further improving andperfecting of theory of TCM syndrome. Our research work on the early stage aboutkidney-YIN deficiency syndrome is relatively sufficient. We have found thatkidney-YIN deficiency syndrome happens more among sub-health status and it takesthe 3rd place. So we will choose kidney-YIN deficiency syndrome as the entrance,and then study the other typical syndromes.The main clinical manifestation of kidney-YIN deficiency syndrome is that: drycough with little sputum, short breath and pant, dry mouth and throat, even afternoonlow-grade fever, feverish sensation in the chest, palms and soles, hectic fever andnight sweat, dizziness and tinnitus, vertigo and eye acerbity, teeth being flexible or in pain, waist and knee being ache, insomnia and dreamful sleep, spermatorrhea andprospermia, eroticism, flushed cheeks and conjunctival congestion, constipation,scanty dark urine, reddened tongue, yellowish glossy coating of the tongue, threadyand rapid pulse,etc. For a long time, it's clinical diagnosis and treatment was based onthe above-mentioned index. But the same patient may not have all above symptoms,or he will have some symptoms of other syndromes. All this will bring inconvenienceon clinical discrimination of kidney-YIN deficiency syndrome. To study which arethe distinctive characters of kidney-YIN deficiency syndrome, the so-called goldenindex, we have removed the factors disturbed by diseases and try to discover thenature of kidney-YIN deficiency syndrome to provide a train of thought on researchof TCM syndrome' essence. Now the study of the essence of kidney-YIN deficiencysyndrome is still on an unclear and disordered stage. A further synthetical study as awhole is necessary. The theory of proteome of TCM syndrome provides thepossibility of overall evaluation on the essence of TCM syndrome. The serumcontains almost ten thousands kinds of proteins with complicated components. Itincludes various proteins from organs and cells. The pathological and physiologicalchanges of the body on any stage can all be reflected by serum. As a result, it hasimportant practical significance to give an overall valuation on the essence ofkidney-YIN deficiency syndrome with the studies intergrateing proteome and TCMsydrome to explore the related proteins in certain period from the point of serumproteome.【Objective】This research aims to explore a common law of sub-health statusoccuring in different crowds and discuss the causes of sub-health status happening inhigh-danger crowds. So that It can provide directions to the prevention and treatmentof sub-health status through the epidemical investigation on various groups, also tostudy the character of kidney-YIN deficiency syndrome under sub-health status. Itneeds to exclude the disease disturbance factors to explore the essence ofkidney-YIN deficiency syndrome from aspects such as symptom, coated tongue,tongue quality, pulse condition etc. Finally it will use the method of proteome, studymolecular mechanism of kidney-YIN deficiency syndrome in sub-health status,compared with kidney-YIN deficiency syndrome occurring under various diseasestatus, and thus try to find out the molecule essence of kidney-YIN deficiencysyndrome under sub-health status. This study not only has far-reaching significanceon sub-health status prevention and treatment, but also boosts the development of theresearch of TCM syndrome's essence.【Method】First, let the staff and worker scene participating in physical examination fill in the questionnaire of sub-health status, according to the contentsbeing filled by the staff, considering the checking body results and referring to《theclinical golden rule of TCM to direct the research of sub-health(trying out)》, thenjudge the sub-health status. Second, based on the data of the survey and theinformation grasped by the doctor's checking on the spot, discriminate with thestandard of the related TCM syndromes. Next, record the qualified questionnairesinto Epidata3.02, adopt SPSS11.5 to deal with data using Descriptive Analysis,x~2test,Binary Logistic Analysis,Factor Analysis etc. Then analyze statistically theordinary circumstances, influencing factors, distributing of TCM syndromes and thesymptoms, coated tongue, pulse condition which happens in different occupationgroups, and analyze kidney-YIN deficiency syndrome under sub-health status toexplore characters of TCM syndrome under sub-health status, Finally use the methodof combination disease with syndrome, apply 2-DE and bio-mass-pectrometry toseparate and identify different protein spot of kidney-YIN deficiency syndrome undersub-health status, compare kidney-YIN deficiency syndrome under various diseasestatus, study the molecule essence of kidney-YIN deficiency syndrome undersub-health status from the molecular biology point of view, and expect to discover thematerial base of kidney-YIN deficiency syndrome.【Result】Among 6110 inquired personnel, 3981 people are in sub-health status,rating to 65.1%. sub-healthy worker state among them shows to be 66.5%. 792 peopleare healthy, accounting for 13% and 1337 disease people takes 21.9% of the total.This has shown that the vulnerable group of society such as extra-workers leads tohigh occurrence rate of sub-health. Their health condition is not optimistic. Femalestaff and worker has higher ratio on sub-health status than the male, which may haverelation with their peculiar physiology and psychological conditions. Sub-healthmostly happen with people under age 30. With age enhancing, the occurrence ratio ofsub-health is decreasing. This is probably because of the occupation inquired intobeing mostly worker staff. Their age are relatively young. 83.3% are below 30 yearold. so the investigated people are in prejudiced state of age. The morbidity ofsub-health is 68.2% for people with senior school education or below and it decreaseswith the higher education. This is probably that in a factory, the education has closelyrelated to working character, income and positions. The low-educated people can onlybe engaged in the job which are low-paied, simple, machinery. Thus they are moreeasily to be in sub-health status. There are other 12 factors which may causesub-health status on the specially appointed crowd such as enterprise, medical courses in general colleges and universities. Those factors include working overtime often,insufficient sports activities, low income, low working ability, unsatisfyingeducational background etc. Clinical manifestation of sub-healthy crowd is verycomplicated, with symptoms dealing with the body, mentality and society. Forexample: tiredness lack of strength, insomnia, dry throat, abnormity of stool,abdominal distention, anorexia, forgettery, waist and back being ache, hand and footbeing cold, acerbity and swelling of eye, headache, dizziness, tinnitus, feverishsensation in palms and soles, frequent urine at night, losing hair, hypaphrodisia,chest distress, breathing hard, heart-throb, spontaneous perspiration, feeling down,irascibility, inanity, frequent sigh, lags in response, low frequency intercourse, lowwork efficiency, bad interpersonal relationship, pang etc. Farther apply FactorAnalysis, principle of pick-up is latent root＞1, using Varemax and Equamax to rotatefactor. We get 10 factors, combined with medical knowledge, based above result,clinical manifestation of sub-health status can split into 7 types, such as typesociety(Factor 6), type psychology(Factor 1), type fatigue(Factor 3,Factor 4,Factor 9),type discomfort of eye and mouth(Factor 7), type abnormity of stool and urine(Factor2), type menoxenia(Factor 5) and type consticution(Factor 8 and Fator 10). Thisprovide basis for classification, prevention and cure of sub-health status.The study on the distribution of TCM syndromes in 706 people under sub-healthstatus has shown that it is dispersed comparatively and deal with 34 TCM syndromes.Among this only spleen-Qi deficiency syndrome (78 samples), liver-QI stagnationand spleen-Qi deficiency syndrome (75 samples) exceeds 10% with the portion of10.8% and 10.6% respectively. Some other syndromes like liver-kidney-YINdeficiency syndrome(69 samples),kidney-YIN deficiency syndrome (65samples),liver-QI stagnation syndrome(51samples),kidney-YANG deficiency syndrome (44samples) are also relatively much, respectively accounting for 9.7%, 9.2%, 7.2%,6.2%. The happening chance of other syndromes is below 5%. This indicates that theTCM syndromes of sub-health status gives first place to deficiency syndrome andhave close relationship with viscera such as heart, lung, liver, kidney, spleen. Thereare only 51 cases of liver-QI stagnation syndrome taking 7.2% and 12 cases ofliver-heat bloom syndrome with portion of 1.7%, which shows that too big mentalitypressure is one important factor leading to sub-health status. A further study on 65cases of kidney-YIN deficiency syndrome under sub-health status has shown that themain clinical menifetation of kidney-YIN deficiency syndrome under sub-healthstatus are: waist and back being ache, tiredness lack of strength, feeling leg and kneeweak, dry throat, insomnia and dreamful sleep, losing hair, night sweat, constipateion, tinnitus, eye acerbity, feverish sensation in palms and soles, etc. In addition, othersymptoms are less, such as heart-throb, bad memory, dizziness, hypoacusis, giddiness,eye swelling, lags in response, scanty dark urine, hypaphrodisia, numbness of handsand feet, being fear of heat, laziness, etc. A further research using Factor Analysisshows that characters of kidney-YIN deficiency under sub-health status are:1.Manifetation of Damage on kidney function(mainly waist and back being ache,tiredness lack of strength, feeling leg and knee weak, losing hair, tinnitus);2.Manifetation of deficiency of liquid(mainly eye acerbity, dry throat, constipateion,etc); 3. Manifetation of hyperactivity of fire due to yin deficiency and heart soultroubled by heat(mainly, night sweat, feverish sensation in palms and soles, insomniaand dreamful sleep, ect); 4. Manifestations of tontue and pulse of kidney-YINdeficiency syndrome are mainly reddened tongue and deep slim pulse. These providebasis for standardization research of kidney-YIN deficiency syndrome and nestestablishment of making a diagnosis and giving treatment for sub-health status.Two-DE Analysis of different diagram shows that there are 31 protein spotsexpressing obviously and differently in 4 experimental groups. There are 5 proteinspots in kidey-YIN deficiency syndrome under sub-health status, SLE and DNexpressing more than normal. We choose 3 protein spots to make a PMF massspectrum appraisal whose expression level change obviously and ascertain one spot isHSP27, this shows that HSP27 has close relationship with kidney-YIN deficiencysyndrome under sub-health status.【Conclusion】The health situation such as worker, teacher, medical personneldoes not admit sanguine and brooking no delay to take measures. It has received goodeffect to study the essence of kidney-YIN deficiency syndrome with the sub-healthystatus study as the entrance. We have discovered some characteristic symptoms ofkidney-YIN deficiency syndrome. We also apply the method of proteome to basicallystudy the molecule essence of kidney-YIN deficiency syndrome under sub-healthstatus and have discovered a few related differential serum protein, and ascertain onespot is HSP27. It shows feasible to study the essence of kidney-YIN deficiencysyndrome from the angle ofproteome.